1522. Initial Clinical Response of Children with Extended-Spectrum Cephalosporin-Resistant Urinary Tract Infections (ESC-R UTI’s) Started on Discordant Antibiotics
Session: Poster Abstract Session: Urinary Tract Infection
Friday, October 5, 2018
Room: S Poster Hall

Background: ESC-R UTI’s in children are often resistant to common empiric regimens. Our objective was to describe the initial clinical response of children with ESC-R UTI’s while on discordant antibiotics.

Methods: We conducted a multicenter retrospective chart review of children <18 years with ESC-R UTI’s presenting to an acute care setting of 5 children’s hospitals and a large managed care organization from 2012-2017. ESC-R UTI was defined as having a urinalysis with positive leukocyte esterase or >5 white cells per high power field and urine culture with ≥50,000 colony-forming units per milliliter of E. coli or Klebsiella spp. non-susceptible to ceftriaxone. Children were included if they received initial discordant antibiotics (an agent to which their isolate was non-susceptible) and had phone or in-person follow-up when urine culture susceptibilities resulted. Children with urologic surgery, immunosuppression and non-renal chronic conditions were excluded. Outcomes were: 1) Escalation of care, defined as an emergency room visit, hospital admission or intensive care unit (ICU) transfer while on discordant therapy and 2) Clinical response at the time of follow-up, classified as improved (complete or partial resolution of presenting symptoms) or not improved (persistence of symptoms) and assessed by a second reviewer in 20% of charts to determine inter-rater reliability.

Results: Of 253 children with ESC-R UTI’s, 76% were female, median age was 2 years (interquartile range [IQR] 0.5-6.5) and 88% were started on cephalosporins. Median time to follow-up was 3 days (IQR 2-3). Nine children (4%) had escalation of care without ICU transfer. Follow-up records with clinical response information were available for 187 children (74%); 154 (83%) were improved and 33 (17%) were not improved (κ=0.80). Figure 1 shows improvement by symptom. In children with repeat urine testing while on discordant therapy, pyuria improved in 12/15 and urine cultures sterilized in 10/13.

Conclusion: Most children with ESC-R UTI’s experienced initial clinical improvement while on discordant antibiotics. Future studies should prospectively evaluate the in vitro and clinical effect of discordant therapy in children to assess the need for modified urine-specific breakpoints.


Marie Wang, MD, MPH1, Vivian Lee, MD2, Tara Greenhow, MD3, Jimmy Beck, MD4, Michael Bendel-Stenzel, MD5, Nicole Hames, MD6, Corrie McDaniel, DO4, Erin King, MD5, Whitney Sherry, MD6, Deepika Parmar, MD7, Sara Patrizi, DO7, Nivedita Srinivas, MD1 and Alan Schroeder, MD1, (1)Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, (2)Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, (3)Pediatric Infectious Diseases, Kaiser Permanente Northern California, San Francisco, CA, (4)Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, (5)Children's Minnesota, Minneapolis, MN, (6)Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, (7)Pediatrics, Kaiser Permanente Northern California, Oakland, CA


M. Wang, None

V. Lee, None

T. Greenhow, None

J. Beck, None

M. Bendel-Stenzel, None

N. Hames, None

C. McDaniel, None

E. King, None

W. Sherry, None

D. Parmar, None

S. Patrizi, None

N. Srinivas, None

A. Schroeder, None

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